Best Health Insurance Plans in India 2020

Drafting a sound financial plan is challenging to an individual for reasons more than one. The primary aim of the plan is to cater for financial cover for life goals and long term wealth creation in the form of a healthy financial corpus to ensure a contented retired life for self and family alike. The front runner tool in this exercise is the different types of life insurance plans, serving the purpose of meeting individual needs, both in the short and long terms. Life insurance plans look after the protection of the family as well as long term money growth.

However, uncertainty prevails in the area of healthcare, the need for, which can hardly be predicted.  Any medical condition that warrants hospitalization and long term treatment can make a dent in one’s savings and ruin the basis of any financial plan. Coupled with the unpredictability of medical emergencies, it is the double-digit healthcare inflation that is worrisome, as compared to single-digit inflationary impact in other means of sustenance. A suitable comprehensive health insurance is a sensible solution to counter this deficiency. Once the insurance sector was liberalized in 2000, there was an influx of global insurance players into the country. The outcome was not only felt in innovative life insurance products but also innovative Health Insurance products in sync with the needs of modern Indian society, which provided a huge market for best health insurance in India.  With a market potential of 1.3 billion Indians waiting to be covered, health insurance plans in a spectrum of hues became a reality, both in the portfolio of Life and General Insurers.

What is health insurance?

Health insurance is a special insurance product designed to cover the medical and surgical expenses of the insured. It takes care of all the medical expenses arising out of illness or injury by paying directly to the caregiver like hospitals and clinics or reimbursing them subsequently. 

Best health insurance can be described as a cover for future medical expenses of the insured. By definition, it is an agreement between the insurer and the insured, where the former guarantees to compensate for medical costs if the latter is hospitalized due to illness or injury. Insurers have tie-ups with a network of hospitals to provide seamless cashless treatment experience to the insured.

Usually, health insurance falls in the domain of General Insurance, as life risk cover is not involved. Other than General Insurance Companies, Health Insurance is also offered by Life Insurance companies in India. Thus, comprehensive health insurance cover is a critical financial tool for the individual.

Why is the best medical insurance needed?

Having understood what medical insurance is all about, it is to summarize the reasons why choosing the best health insurance policy makes sense.

• Primarily, top health insurance guarantees to pay for future illnesses and related treatment without depleting savings or adversely compromising the financial future of the family
• Remaining financially ready for medical emergencies with savings may prove to be grossly inadequate considering high healthcare costs with a disastrous outcome
• Extremely convenient to avail of cashless treatment in networked hospitals and reimbursement in other cases
• Most health insurance plans offer wide coverage concerning ailments and procedures, apart from generous features related to all aspects of treatment, including pre and post hospitalization requirements
• Being covered with one of the best health insurance plans provides peace of mind concerning meeting medical contingencies

Types of Best Medical Insurance in India:

Health insurance funds medical emergencies of the insured, which is a daunting task in the present healthcare scenario in the country. Any worthy health insurance policy is flexible to cover a range of diseases and surgical procedures, with certain plans covering up to 30 critical illnesses and 80 surgical procedures, respectively. On top of that, the best health insurance plan pays for the medical expenses regardless of the cost within the limit of sum insured, and the policy continues for the full term, even after the benefit is paid. It needs an in-depth look at the different plans aspiring to be the best health policy in India.

Individual Plan:

The individual plan extends coverage to a single individual for meeting medical emergencies.

Family Floater Plan:

This is a single plan where health coverage is extended to the entire family comprising of a spouse, dependent children, or sometimes parents and other relations. The sum insured can be used singly or severally for the entire amount.

Senior Citizen Plan:

Senior Citizen Plans are specially designed to cater to the health insurance needs of senior citizens, i.e., persons above 60 years of age.

Critical illness Plan:

It is a standalone plan, unlike a Critical Illness Rider designed to cover specific ailments considered critical. The number of ailments like renal failure, heart attacks, stroke, or even cancer varies with insurers.

Personal Accident Plan:

Personal Accident Plan covers for hospitalization due to injuries caused in an accident.

Maternity Plan:

A maternity plan is designed to cover pregnancy and childbirth. The newborn is also covered up to a certain age.

Unit Linked Health Insurance Plan:

As the name suggests, these are dual-purpose plans providing health cover in addition to the creation of a corpus of added coverage.

Hospital Daily Cash Benefit Plan:

This defined plan offers a daily cash allowance during the stay in the hospital, as well as convalescence. The range and scope may vary with insurers.

Disease-Specific Plan:

This plan caters to the healthcare needs related to the specific disease. Some examples are Cancer care, Heart care, or even Dengue care, etc., to name a few.

Top-Up and Super Top-Up:

These are plans, which work on the principle of the deductible. It helps to substantially increase the cover amount over and above a base health insurance policy. The other important benefit is that this plan can be bought for the fractional cost of the base policy.

Pro-Active Plan:

It is designed to manage health better in chronic conditions based on medical, behavioural and lifestyle factors.

Understanding Terminology in the Best Health Insurance Plan in India:

The first thing one need to fathom is the different terminologies used in health insurance. Until and unless one is well conversant with the jargon, it will not be possible to comprehend what is of offer and check various inclusions and exclusions. It is thus imperative to decipher what the terms mean and its implications.

Day Care:

Normally, health insurance or Mediclaim comes into play once the insured is hospitalized. However, immense technological advances in healthcare permit many procedures and treatments to be performed in facilities of Day Care in less than 24 hours, where overnight stay in the hospital is not necessary. A typical example is Dialysis. Best Medical Insurance Policy will invariably cover several procedures for Day-care cover. Bigger the list, better it is.

Restoration Benefit:

It is a provision by, which the incurred benefit is restored using a refill during the policy term so that the sum insured remains unchanged. Restoration of Benefits is permitted up to 100% in a year. However, the premium cost for such plans are higher.

Domiciliary Hospitalization:

It is a situation where treatment is warranted in a hospital in the normal course but is compelled to be undertaken at home. The reasons can be:

• The condition of the insured patient does not permit shifting to a hospital.
• There is no accommodation in the hospital for the admission of the insured patient.

AYUSH:

It is an alternative treatment that some health insurance accommodates. It is an acronym for Ayurveda, Unani, Siddha, and Homeopathy.

Co-Payment:

Many health insurance plans incorporate the clause, which mandates bearing a percentage of the claim amount by the insured. While it lowers the premium, co-payment may make a dent in one's savings.

Cumulative Bonus:

It is similar to claim the discount, where the sum insured increases by 5% every claim-free year. However, such a cumulative bonus can enhance the sum insured to only a percentage of the base amount in most plans.

Deductible:

It is the other name of loss borne by the insured. It is normally a percentage of the claim amount or a fixed sum, as in the case of Top-Up policy. Higher the deductible, lower the premium.

Waiting Period:

It is the timeline compulsorily imposed to admit the cover for pre-existing diseases. The period can be as high as 48 months, which most insurers impose.

Sum Insured:

It is the amount of cover or pay-out, either paid directly to the caregiver or reimbursed. If a policy has a cover of Rs, 5 Lakh, and the hospital claim is Rs 2 Lakh, then Rs 2 Lakh is paid, and the fresh cover is Rs 3 Lakh for the remainder of the policy term.

TPA:

It is an acronym for Third Party Administrator, which is a body that processes claims under a mediclaim policy. They are either independent or belong to an insurer. They operate under license of IRDAI and facilitate cashless treatment in networked hospitals, where they maintain their desk.

List of Best Health Insurance Plan in India in 2020:

Below is the list of the best health insurance plans in India in 2020:

Disclaimer: *Paisawiki does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

Salient Features of the Best Health Insurance Policy in India:

The key to choosing the best health insurance lies in understanding the features that one is likely to get from a particular plan. Meticulous analysis of all the features helps in making an informed choice to ensure adequate coverage to protect the family from the uncertainty related to a health emergency.

Age Eligibility:

The usual age range for purchase of health insurance policy is 18 to 65 years

Renewability:

Most of the insurers offer the facility of lifetime renewal, which ensures cover until a very ripe age

Cover for Medical Emergency:

A suitable Mediclaim or health insurance policy provides just the requisite cover for meeting the cost of medical emergency without depleting family savings. Healthcare costs typically lead to heavy erosion of financial resources, until covered by medical insurance.

Mode of Pay-out:

Health insurance provides for both cashless treatment as well as reimbursement of medical expenses, typically related to hospital treatment. Insurers offering health insurance have a wide network of hospitals to facilitate cashless treatment, which turns out to be highly convenient.

Network Hospitals:

A large number of Network Hospitals ensures seamless cashless treatment.

No Claim Bonus:

Insurers sometimes enhance the sum insured for years when there is no claim. No claim bonus can also be cumulative, provided there are consecutive no-claim years.

Medical Check-Up:

Generally, insurers provide a facility for free health check-ups as an incentive for no claim years.

Medical Screening:

It is a pre-policy feature with the varying age range for the issue of the policy document. Generally, it is waived for individuals till 45 years of age, for some insurers, the age is higher at 55 years.

Geographical Coverage:

It allows global coverage for planned and emergency cashless hospitalization.

Organ Transplant:

Surgical procedure for an organ transplant as an add-on with a customized cover.

Key Benefits of the Best Health Insurance Policy in India:

Before buying a health insurance policy in India, one must be well-aware of the core benefits offered by that plan. Some of the key benefits of the best health insurance policies in India are as follows:

Pre and Post Hospitalization Cost:

It is typically covered in health insurance, but may not be so in Mediclaim. The number of days for, which cover is provided is in the range of 30 to 90 days. It covers OPD, Doctor’s consultation, Diagnostic Test costs, and medicines.

Room Rent and ICU Cover:

These are covered by health insurance, with their limits varying. Some insurers provide for limits based on the percentage of the sum insured. These impact the overall cost of reimbursement as they are interlinked. It is wise to opt for liberal rent features rather than limited ones.

Lump-Sum Payment for Critical Illness:

The feature related to listed Critical illness varies in the pay-out of health insurance. A lump sum amount equivalent to the sum insured is paid out on the diagnosis of the critical illness regardless of the incurred medical expenses.

Add-on:

The best health insurance policy offers several add-on covers, including loss of income due to accident.

In-built Cover:

The best health plan will also offer comprehensive maternity coverage both in pre and postnatal stages, including childbirth and insurance for the newborn for a limited period. However, there is a waiting period of 9 months.

Nursing Expenses:

It is admissible for cashless as well as reimbursement of medical expenses.

Cost of Transportation:

Ambulance charges are reimbursed subject to certain limitations.

Daily Cash Payments:

Some plans provide daily cash allowance during the period of hospitalization. Additionally, it is also provided for convalescence. The quantum and number of days to be covered can differ with plans.

Tax Benefit:

The health insurance premium is considered for tax saving deduction under Section 80D as per IT Act, 1961. The eligibility for the deduction pertains to self, spouse, dependent children and parents, with the quantum related to age.

Mediclaim Policy in India vs. Best Health Insurance Policy in India:

Most Indian customers are clueless about the difference between Mediclaim and Health Insurance, often making the mistake of equating them. In everyday parlance, it may seem to be the same, but they differ in many ways. A proper understanding of them is imperative when it comes to buying the right plan for meeting medical emergencies in harmony with the family health profile.

Mediclaim Policy: 

It is a health cover for illness, surgery, or accident for treatment undertaken in hospital primarily, but also permits domiciliary care in certain circumstances. Broadly, Mediclaim confines itself to hospitalization or Nursing home treatment.

Health Insurance Policy:

It is a comprehensive health cover accommodating medical expenses for illness, surgery, and accident beyond basic hospitalization. Thus it caters to pre and posts hospitalization medical expenses, ambulance charges, Day Care treatment, OPD treatment, Critical illness cover and many more expenses related to medical emergencies.

Takeaway:

The final verdict on Mediclaim vs. Health insurance is a difficult proposition, considering all the aspects. It is heavily dependent on individual needs. If the aim is an immediate cover for medical emergencies, Mediclaim may suffice. However, comprehensive cover for Spouse, dependent children, and parents can be provided only by Family Floater Health Insurance for flexibility and customization.

Complete Retail Health Insurance Portfolio in India:

While it is a good idea to identify the Best Health Insurance Plans in India, it has to be remembered that the selection is only in relative terms and not absolute. It is a fact that there is no dearth of different health insurance plans in India. Yet, each plan has something unique or new to offer, across all insurers. Added to that is the geographical presence, which can influence the purchase from a particular insurer only. In such circumstances, it is logical to study the entire range of health insurance policies in India both for academic interest and to make an informed choice. Accordingly, a collection of health insurance across all insurers operating in India is appended below. It has to be importantly noted that health insurance is a non-life insurance product, is designed and marketed by the General Insurance Companies exclusively, or the General Insurance arm of Life Insurance companies. There are a few exceptions, where Life insurance companies also offer health insurance products.  

How to apply for Best Health Insurance in India?

Health Insurance was introduced in our country for the first time in around 1986. The whole genre has come a long way since then. A quantum jump in the variety and innovative health insurance products took off after liberalization in the insurance sector in 2000. The advent of international insurance players in the Indian market provided the requisite impetus with fresh ideas in the field of health insurance. The low penetration of health insurance helped the sector grow exponentially. Thus, today the customer is spoilt for choice in the variety of health insurance plans. Coupled with the large portfolio of health insurance products, the delivery channels are also far too many, ensuring customer ease. There are thus mortar and brick offices, agents, brokers, and above all, robust portals offering purchase of plans online. Application for best health insurance can be categorized into two – Offline and Online.

Offline Mode:

The process is not very elaborate and uniform with all the insurers. It can be defined in a few steps.

• Check out the different policy brochures and understand the various benefits, inclusions, exclusions, and premium with the help of advisors, before choosing the best suited
• The proposal form must be completed with all information, including health-related transparently
• Submit the form with requisite documents and the premium cheque
• Complete the pre-policy medical screening as per norms of the prescribed age band
• Once these formalities are completed, the processing of the application is done and policy document issued

Online Mode: 

It is a handy tool, especially patronized by the current generation, because of its inherent advantages and ease of operation. The steps are defined as:

• Visit the portal of the insurer or the aggregator. Compare the plans online and use the calculator to check for eligibility and suitability
• Invoke the “Buy Now” Tab and fill in the necessary information including smoking habits; Non-smokers are rewarded with a lower premium
• Choose the sum assured, the policy term. premium payment mode, add on options and submit to proceed
• Await the quote and if accepted, pay the premium online
• Complete the proposal form and upload requisite documents
• Comply with the pre-policy medical screening, if applicable
• Wait for processing of the application and receive the policy document at the registered Email

Factors that Impact Premium of Best Health Insurance:

Age:

There is no denying reality, that the possibility of falling sick increases with age. Younger people are in lesser need of medical assistance as they are generally healthy. Driven by the same vital logic, the premium for health insurance is lower for younger people rather than when one is older. It is smart to purchase health insurance at an early age to get the benefit of low premiums. 

Habits:

Lifestyle habits play a vital role in determining the cost of the premium. Thus smokers or those who consume alcohol, as a matter of routine, are charged a higher premium for the simple reason that they carry a higher risk of diseases. 

Body Mass Index:

It is a ratio derived concerning the weight and height of an individual. A higher BMI signifies an unhealthy lifestyle, resulting in obesity, making one vulnerable to diseases of heart, joint, and diabetes needing frequent medical assistance. The premium goes up for such individuals. 

Medical History:

Family history of certain diseases makes one prone to suffer from them, much more than with a clean history. Diseases like cancer, hypertension, and cardiac ailments fall in this category. Individuals with a history of these diseases attract higher premiums. 

Pre Existing Diseases:

Persons with pre-existing diseases have to pay a higher premium because the possibility of repeat medical assistance in them is high.

Profession:

Professional hazards also play a role in determining the cost of the premium. Some professions carry a higher risk of illness, like mining, which calls for higher premiums. 

How to Save on Premium in Best Health Insurance in India?

Once conversant with the factors that impact the cost of the premium, the corollary is obviously to save on it reasonably, without compromising on quality. A health insurance plan not only provides to overcome medical contingencies but also protects the savings corpus.  Therefore, purchasing health insurance is not only essential but mandatory as well. It is smart as well as wise to find the best ways to mitigate the cost of the premium as far as possible. 

Start Young:

Premium is lowest at the early stage in life when there are hardly any medical issues to confront. It is this stage of life, that there practically any need for medical assistance. Yet, it makes sense to purchase one of the best health insurance plans, as the premium is low.

Stick to Basic Coverage:

Instead of choosing disease-specific health plans at a higher rate, it is prudent to purchase basic health insurance and opt for riders solely based on specific needs and health profiles. 

Choose Family Floater Health Insurance:

Since the ambit of cover is for the entire family, it turns out to be beneficial in terms of the cost of the premium as compared to individual plans for each member of the family.

Look for Top-up Options:

The coverage can be substantially augmented with the help of Top-up policy, at a fraction of the cost of an independent health plan. The trick is to purchase a health plan of reasonable financial coverage and enhance it with a Top-up at a low cost. However, it is preferable to keep deductible out from the chosen Top-up.

Choose No Claims Bonus Plans:

Many insurers add to the sum insured based on claim-free years. The increase in percentage is substantial for serious consideration. 

Maintain Healthy Lifestyle:

It adds to the profile of the customer who is a non-smoker and non-drinker. Most insurers offer a discount to non-smoking customers. Even, the benefit may be availed after one quits smoking during the policy term.

Consider Online Purchase:

It is the best option, as the low overhead cost is passed on to the customer resulting in a lower premium.

Things to consider while buying the best Health Insurance Plan in India:

Having understood the absolute necessity of a health plan in one’s life, a simple nagging question, "Which Is the Best Health Insurance Policy," to buy is not unusual. After all, aspiring for the best is a matter of compulsion and not choice in such a crucial protection tool. In this light, there are a few cardinal rules, which can help fulfil the desire to buy the best health insurance plan, which is value for money,

Look for Adequate Coverage:

The focus, without doubt, has to be on not compromising on the quantum of cover for the family, and make the best of the premium paid. Any deficiency will cost dearly in the future, as payment goes from the pocket to clear what the plan does not

Geographical Presence:

A large network of hospitals tied up with the insurer helps in a medical emergency if located near the residence. It is ensured by checking out the geographical umbrella of the insurer

Understand Coverage Width:

It is essential to comprehend the impact of the cover provided, as it will be crucial in medical emergencies. Wide cover of ailments and situations with the least number of exclusions is ideal.

The Size of Premium:

More often than not, the premium cost takes precedence over other considerations. Focusing primarily on its size can be misleading, as, in the long run, additional features like co-payment can be a drain on the pocket. Finding a balance between the allocated budget for health insurance, its draining clauses compensate in the long run, however, the cost of premium can be somewhat lowered through online purchase

Having covered the major aspects to consider while buying the best Health Insurance Plan in India, it is not out of place to check up on a summary of some useful tips for making a good purchase.

• Buy a policy at an early age, as the premium is higher as one grows old
• Choose the right cover for the family size
• Unhealthy lifestyle needs higher cover
• Family Floater plan should always be supplemented by a top-up or super top-up policy for additional cover
• Choose health plan with least exclusions and without co-payment
• Lifetime renewability is the only worthy plan to choose
• Health insurance should ideally cover critical illness too
• Avoid plans with claim loading
• Understand the implication of high waiting period for pre-existing diseases
• Understand the impact of treatment at Network and Non-network hospital
• Check for old age ailment cover for plan related to parents
• Never hide any health-related information while purchasing health insurance
• Opt for a separate individual plan for self and spouse, as one gets older, to negate the disadvantage of floater plan terminating on the demise of the proposer

Which is the Best Health Insurance Policy?

The above bullet points to consider before buying the best health insurance plan in India is practically a checklist. But, having such a wide choice of plans to consider, one is clueless about what is right. In such a scenario, understanding and learning some of the aspects in greater detail is the only way to compare among them and arrive at an informed choice. Thus, the following information is of utmost importance to find a suitable answer to the question posed.

Day Care:

The basic principle of Day Care has already been explained earlier.  However, studying it in greater detail is imperative, considering its underlying importance in the modern age, where best health insurance is an intrinsic component of long term financial planning. The grouse about its impact is genuine, considering that standard health policies do not cover normal visits to the doctor, and bills for related medication entail huge financial drain. Yet, they are not included in standard health policies. It is opined that the cumulative cost of Day Care procedures, usually at a conservative estimate, is twice that of hospitalization cost. It is for the simple reason that medical technology advancements have resulted in redefining many treatment procedures, free from restrictions of 24 hours hospitalization. Thus, Day Care at the cost of repetition can be described as treatment procedures that require hospitalization for less than 24 hours Some of the common procedures in this category are chemotherapy, dialysis, cataract, tonsillectomy, radiation, and lithotripsy to name a few; With the IRDAI advocating more product innovations, the list is growing by the day. Here is a list of the common indicative procedures that find a place in the best health insurance today.

OPD and Maternity Cover:

The advent of a clutch of insurers post liberalization of the insurance sector in 2000 has resulted in many innovative inclusions in the best mediclaim policy on the table. Few insurers embrace coverage for Outpatient Department (OPD), Dental and Maternity expenses that do not require overnight hospitalization and yet not included in Day Care. By nature, these entail small recurrent expenditures in comparison to costly Day Care procedures. The best health insurance plan for OPD typically pays pharmacy bills, besides consultation fees, diagnostic expenses, dental treatment, and maternity, often with sub-limits. However, such plans are few and far between. The basic reason is that the proportionate cost of the premium goes up substantially. Evaluating the cost-benefit ratio, it is evident that there are hardly any takers for such plans.

Critical Illness:

The incidence of lifestyle diseases is part and parcel of modern living. Diabetes, Cardiovascular, and Cancer are some of the common chronic critical illnesses, which afflict a vast cross-section of our society across all age range. Its management, in the short term in hospitals as well as in the long term care, costs a bomb and is a severe drain on the financial resources.

The incorporation of cover for critical illness was a natural progression in the best health insurance policies. It is not only a regular inclusion in best health insurance, which is a non-life insurance product but also offered as an optional rider in pure life insurance protection plans as well, generally referred to as Term Plans.

Apart from its cover in best medical insurance, as standalone critical illness plans, there are a host of unique health insurance plans, which cover specific diseases like Cancer and Heart. The basic difference in plans for critical illness and health insurance is in the claim process. While in the former, the sum insured is paid out in lump sum on diagnosis of the listed disease regardless of hospital expenses; in the latter, claim for expenses is routed through either cashless treatment or subsequent reimbursement on submission of documents. Like in Day Care, it is wise to check for the list of diseases covered or defined for a selection of the best health insurance in conformity of the health profile of the customer.

The list tabulated below is only indicative. It is proper to check the coverage with individual insurers.

Inclusions:

This is an important aspect that is required to be well comprehended by the policyholder. There are standard inclusions as well as some special, which makes one plan different from the other, helping to choose the best health insurance. It is, in any case, absolutely imperative to be acquainted with the inclusions, both for cashless and reimbursement treatment. Some of the major components for particular attention are:

Bed Charges:

Usually, hospitals have General Beds or Cabin of different categories. Then there are ICU related charges, which are higher as compared to beds. The tariff varies according to the category. Best Health Insurance has variable measures for rent capping. Some insurers limit the maximum to fixed amounts for beds and ICU separately. While some employ a percentage of the sum insured to define the limits.

The lower the sum assured, the lower is the limit for bed rent. As an illustration, for a sum insured of Rs 5 Lakh, if the bed rent is defined as 1%, it comes to Rs 5000. If it is 2%, the rent is doubled to Rs 10000, but there is a catch. The cost of services incorporates hospitals that are linked to the category of beds and amount, impacting the final bill. It may result in paying the higher amount at the time of discharge in cashless and a lower reimbursement amount, subsequently. 

Hospitalization Expenses:

It covers expenses covering the bed, boarding, consultation, diagnostic investigations of all types, OT charges inclusive of all medical equipment and appliances needed in surgery, surgeon and anaesthetist fee, medicines, medical consumables, physiotherapy and nursing charges.

Pre-hospitalization Expenses:

Almost all best health insurance cover for this expense, which is limited to the number of days. Generally, it covers expenses of OPD type comprising Doctor's fees, Diagnostic expenses, Pharmacy bills up to 30 days before admission in a hospital. 

Post-hospitalization Expenses:

All the expenses covered in Hospitalization and Pre Hospitalization are eligible in this category. Most of the insurers limit the period for cover to 60 days, while some extend it further to 90 days.

Domiciliary Hospitalization:

It is a situation where the patient is needed to be hospitalized but is compelled to be treated at home due to extraneous reasons, like unavailability of bed in the hospital, etc. The best health insurance covers it in India.

Restoration Benefit: 

It is a facility common mostly in best health insurance policy, by, which the sum assured is reinstated after it is exhausted due to claim payments. It acts like backup recharging the sum assured to ensure that no future claim is repudiated due to poor balance. It is particularly beneficial in family floater accounts, where other members may be vulnerable if any one member has to make a claim. However, policyholders must understand that there are limitations to the benefit.

• Even if the sum assured is restored, claim for the same ailment, which has been treated will be denied
• It is not available for the first claim in the policy year, with the exception being hospitalization due to accident
• While most health insurance plans reinstate the sum insured only on complete exhaustion. However, there are a few, which recharge on partial exhaustion also
• The restored sum insured has to be consumed in the same policy year, as it is not carried forward

Ambulance Charges:

The treatment related to ambulance cover, vary from plan to plan. Some relate it to the quantum of sum assured, defining eligibility confined to higher amounts. Further to this, even the best Mediclaim insurance limits the maximum eligible expense. In the present day, where best health insurance globally accepted, Air Ambulance charges are also part of the eligible expense.

Exclusions:

It is one of the essential facets of best health insurance in India is the range of exclusions in them, limiting the choice of policyholders. Some of the key parameters to consider are:

Initial Waiting Period:

It is the period compulsorily excluded for acceptance of claim after the commencement of risk. The periods vary, with insurers and specific plans, but the industry standard is 90 days. In exceptional best medical insurance, the period can be lower, or from day one itself.

Survival Period:

It is applied to specific covers for critical or terminal illness, from the date of diagnosis. It is defined as the waiting period after diagnosis of the listed ailment, for settlement of the claim as per agreed terms. The industry standard is 30 days, with exceptions of 15 days in select plans.

Pre-Existing Disease (PED):

A pre-existing disease is defined as any medical condition, ailment, or injury that was already diagnosed and existed at the time of purchase of the best health insurance plan. However, recently IRDAI has clarified on 27th September 2019, that any ailment or disease diagnosed within 3 months of purchase of best health insurance plan, will be deemed as Pre-existing Disease (PED), in fresh guidelines for the standardization of health insurance. The norm applies to all health policies filed after 1st October 2019. However, for existing health contracts, the new norm will come into effect from 1st October 2020. Usually, the waiting period for cover extending to PED is 48 months. In some cases, it may be lower at 36 or 24 months. The general thumb rule applied to PED is:

• 2 to 4 years: PED
• 1 to 2 years: Conditions like Osteoporosis, Hernia and some ENT related disorders
• 2 years for Spinal Disorder, Joint Replacement, Internal Tumours, Cysts, Polyps, Cataract, Tonsils, etc.
• 90 days for newborn babies

General Exclusions:

• Self-inflicted bodily harm, arising out of suicide or attempt to suicide
• Medical condition attributable to alcohol, drug, intoxicants or substance abuse
• Any congenital disease
• Any harm arising from indulgence in dangerous sports or activities
• Participating in criminal or illegal activities
• A medical condition resulting from nuclear peril, radioactive, chemical, or biological contamination. war, conflicts or similar activities

Treatment Exclusions:

• Treatment-related to lifestyle conditions like obesity, weight loss, etc.
• Cosmetic surgery
• Dental, Vision, and Hearing problems are other than needed for injuries sustained in accidents requiring hospitalization. However, aid like spectacles, contact lenses, etc. are excluded

FAQs: